2型糖尿病合并冠心病多支血管病变血运重建方式选择

目的：比较2型糖尿病（type 2 diabetes mellitus，T2DM）合并冠心病多支血管病变患者接受经皮冠状动脉介入治疗（ percutaneous coronary intervention ，PCI）或冠状动脉旁路移植术（ coronary artery by-pass graft，CABG）3年后的预后情况，探讨该类患者如何选择再血管化治疗方式。方法选择2009年5月1日至2010年5月31日于天津市胸科医院连续进行的冠状动脉造影（ coronary angiography ，CAG）确诊T2DM伴多支血管病变并成功行PCI或CABG治疗且病例及随访资料完整者，进行为期3年的随访，收集患者一般情况、临床指标、实验室检查指标等信息，分析死亡、心肌梗死、再次血运重建、再发心绞痛、心力衰竭、卒中等主要不良心脑血管事件（ major adverse cardio cerebral events ，MACCE）。结果3年期随访显示，PCI组MACCE发生率显著高于CABG组（31.58％ vs 17.68％，P＜0.01），PCI组心源性死亡（4.82％vs 1.10％，P＜0.05）、心肌梗死（4.39％ vs 1.10％，P＜0.05）及再发心绞痛（17.27％ vs 10.50％， P＜0.05）发生率较高。结论与PCI相比，CABG仍然是目前T2DM合并多支血管病变患者血运重建治疗的更好方法。

Comparison of different multivessel revascularization methods in type 2 diabetes mellitus patients accom-panying with coronary artery disease

Objective To compare two different revascularization methods in type 2 diabetes mellitus （T2DM） patients with multivessel coronary artery disease treated by percutaneous coronary intervention （PCI） and coronary artery bypass graft （ CABG） .Methods T2DM patients with multivessel disease undergoing successful PCI or CABG were enrolled in the study .They were diagnosed by coronary angiography （ CAG） in Tianjin Chest Hospital from May 2009 to May 2010 whose.The patients were followed up for 3 years.The information of patients including physical performance , clinical features , and laboratory examination results were collected .The major ad-verse cardio cerebral events（MACCE）including death, myocardial infarction（MI）, revascularization, angina pectoris, heart failure, and stroke were collected.Results During the 3 years of follow-up, MACCE（31.58% vs 17.68%, P〈0.01）, death（4.82%vs 1.10%, P〈0.05）, MI（4.39%vs 1.10%, P〈0.05）, angina pectoris （17.27%vs 10.50%, P〈0.05）occurred more frequently in PCI group than in CABG group .Conclusion Evidences now tend to support CABG for revascularization in T 2DM patients with multivessel disease .